Head control is so important for every day life. By increasing head control even just slightly for a child or adult it can mean opened opportunities for communication and mobility. It allows increased choices for communication devices and it can allow for the uses of switches that can control wheelchairs or other mobility options. This increased control will allow for more independent and meaningful participation in day to day life which is what the goal of therapy is.
Head control starts when they are little. When babies are born they have no head control. As they get stronger they slowly learn to control their movements. Initially they have the strength to lift their head if it is too far forward or back or to the side, but they often overshoot where they are going because they don’t know how to grade their movement. Grading comes with practice. And as they grade (which means they know just how much they need to turn on their muscles in order to get their head to exactly where they want it), they learn how to keep it where they want it. This requires control. They figure out just how much muscle effort needs to happen from all the different muscles groups, and how to have those muscle groups work together to keep their head aligned.
As babies grow and develop this it is mostly unconsciously because let’s be honest, they don’t know enough to think, ‘hey I want to lift my head up to see that toy and I will turn on my muscles this much to do it.’ They react to the stimulus presented to them and if they are interested they work to hold their head there for longer periods of time and build endurance. For older kids, this may be a conscious activity where you are asking them to look at something and cueing them on which muscles to turn on and then keeping the motivator there while encouraging them to keep looking. A lot of times I find counting is a big motivator and they try to beat their time. Or if you have a switch where they get to do something they like such as navigate an ipad they will get motivated to do what is needed. But, they are still having to think about it. Ideally with practice they get better at doing this without as much thought because if you are thinking about how to move your head, it’s hard to concentrate on other things as well, such as learning.
One of the ways that I have learned to help with head control is to decrease the degrees of freedom. What do I mean by this? I mean I make it so they only have to focus on their head and neck muscles. This could be by me giving them maximal support of their trunk and body so they don’t have to worry about it, or it could be me using a swaddle on a little one so their body is contained. I can also use my hands for this. As they gain more control with maximal support I will slowly decrease my support by either moving my hands lower on their trunk, or letting their arms be free, or keeping my hands at the same height but relaxing my grip a little bit. It depends on the person and what works for them. The key is to have a motivator for them to be looking at or engaged in. Make it a game!
What are some ways you work on head control and limit degrees of freedom?